Death Certification
Dr. Sulaiman Nimer
For medico-legal purposes; Death is defined as
Complete
Permanent
Perfect
Persistent
Irreversible
cessation of functions of the tripod of life
(BRAIN, HEART AND LUNGS)
Death certification
Permanent legal record that provides personal
information about the decedent, the
circumstances and cause of death, and the
final disposition.
Why we have to write detailed death certificate
• Describe and explain levels, trends and differential in
mortality
• Identify emerging diseases and conditions
• Guide priorities for intervention programs
• Contribute to medical research
• Monitor the impact of public health programs
• Identify areas requiring epidemiological research.
Cause, Mechanism and Manner
Proper certification begins with a fundamental understanding
of cause and mechanism and manner of death.
The cause and manner of death are opinions based on the
available information.
Cause of death is the injury, disease, or combination of the two
that initiates a train of physiological disturbances that, no matter
how brief or prolonged, resulted in the fatal termination of an
individual’s life.
e.g.: a gunshot wound to the head, a stab wound to the chest,
adenocarcinoma of lung, and coronary atherosclerosis
Mechanism of death is the physiological derangement produced
by the cause of death that result in death. e.g.: hemorrhage,
septicemia, and cardiac arrhythmia
Manner of death explains how the cause of death came about
Cause of death
Immediate cause of death is the disease or injury
present at the time of death that caused the
person’s death.
Proximate cause of death is the original natural
disease process, injury, or event that led to a
string of unbroken train of events over an
unlimited time that eventually led to the
individual’s death.
The manner of death
• Natural- when the individual dies as the result of natural
disease processes, without the significant influence of any
type of injury, drug toxicity, or other significant
environmental or other non-natural factor.
• Accident- an event occurring by chance or from unknown
causes, with a lack of intention.
• Suicide- the act of taking one’s own life voluntarily.
• Homicide- the killing of one human being by another
(Criminal, Justifiable)
• undetermined
An individual can die of intracranial hemorrhage
(the mechanism of death)
due to a head trauma (the cause of death)
with the manner of death being
natural ( hypertensive patient)
homicide (somebody hit the individual with a rock)
suicide (jumping on the head),
accident (in RTA),
undetermined (one is not sure what occurred)
Unacceptable causes of death
Unacceptable causes of death are nonspecific and have no
meaning, such as cardiopulmonary arrest, or brain death
Unacceptable causes of death that state only mechanisms
of death such as renal failure, respiratory failure, hepatic
failure, or multisystem organ failure.
Unacceptable causes of death that may be interpreted to
have either a natural or traumatic etiology should be
specified more clearly. For example an “intracranial
hemorrhage”
How we can fill the death certificate?
A 30 year old woman is admitted to the hospital with sudden-
onset vomiting of blood, and is diagnosed as having bleeding
esophageal varices.
Eight weeks previously she had been diagnosed with portal
hypertension.
The woman had a history of hepatitis B infection diagnosed 2
years ago.
5 days following admission she dies
Errors in death certification
Writing only the immediate cause of death or mode of death in
the death certificate, rather than the underlying cause.
Documenting multiple causes on one line. Only one condition
should be documented per line.
Not specifying the site and nature of cancers and other tumors
or local lesions.
Listing clinically improbable sequences.
Not documenting the nature of the injury in the case of deaths
due to accidents, and not distinguishing between accidental or
intentional injuries.
Thank you….
